the aids policies of the former south african president thabo mbeki's government were directly responsible for the avoidable deaths of more than a third of a million people in the country, according to research by harvard university.
south africa has one of the severest hiv/aids epidemics in the world. about 5.5 million people, or 18.8% of the adult population, have hiv, according to the un. in 2005, there were about 900 deaths a day.
but from the late 1990s mbeki turned his back on the scientific consensus that aids was caused by a viral infection that could be fought – though not cured – by sophisticated and expensive medical drugs. he came under the influence of a group of maverick scientists known as aids denialists, most prominent among whom was peter duesberg from berkeley, california.
in 2000, mbeki called together a round table of experts, including duesberg and his supporters, but also their opponents, to discuss the cause of aids. later that year, at the international aids conference in durban, he publicly rejected the accepted scientific wisdom. aids, he said, was brought about by the collapse of the immune system – but not because of a virus.
the cause, he said, was poverty, bad nourishment and general ill-health. the solution was not expensive western medicine, but the alleviation of poverty in africa.
in a new paper (pdf), harvard researchers have quantified the death toll of mbeki's stance, which caused him to reject offers of free drugs and grants and led to foot-dragging on the part of his government over bringing in a treatment programme, even after mbeki – under intense international criticism – had taken a vow of silence on the issue.
"we contend that the south african government acted as a major obstacle in the provision of medication to patients with aids," write pride chigwedere and colleagues from the harvard school of public health in boston in the journal of acquired immune deficiency syndrome.
they have made their calculations by comparing the scale-up of treatment programmes in neighbouring botswana and namibia with the limited availability of drugs in south africa between 2000 and 2005.
expensive antiretrovirals (arvs) came down in price dramatically as a result of activists' campaigning and public pressure. in july 2000, the pharmaceutical company boehringer ingelheim offered to donate its drug nevirapine, which could prevent the transmission of hiv from mother to child during labour. but south africa restricted the availability of nevirapine to two pilot sites per province until december 2002.
under international pressure, south africa did eventually launch a national programme for the prevention of mother-to-child transmission in august 2003 and a national adult treatment programme in 2004. but by 2005, the paper's authors estimate, there was still only 23% drug coverage and less than 30% prevention of mother-to-child transmission.
by comparison, botswana achieved 85% treatment coverage and namibia 71% by 2005, and both had 70% coverage with mother-to-child transmission programmes.
the authors estimate that more than 330,000 people died unnecessarily in south africa over the period and that 35,000 hiv-infected babies were born who could have been protected from the virus and would probably have a limited life.
their calculations will withstand scrutiny, they say. "the analysis is robust," said chigwedere. "we used a transparent and accessible calculation, publicly available data, and, where we made assumptions, we explained their basis.
"we purposely chose very conservative assumptions and performed sensitivity analyses to test whether the results would qualitatively change if a different assumption were used."
the authors conclude: "access to appropriate public health practice is often determined by a small number of political leaders. in the case of south africa, many lives were lost because of a failure to accept the use of available arvs to prevent and treat hiv/aids in a timely manner."
following mbeki's ousting from the leadership of the african national congress in september, south africa is now urgently pursuing new policies to get treatment to as many people as possible under a new health minister, barbara hogan.
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据哈佛大学的研究表明，南非前总统塔博﹒姆贝基政府的艾滋病政策对该国30多万可以避免死亡的人应负直接责任。
南非是世界上艾滋病流行最严重的国家之一。据联合国有关资料，该国约有550万人，即该国成人人口的18.8％，带有艾滋病病毒。在2005年，该国每天都有900人死于艾滋病。
但是，从上世纪90年代末起，姆贝基就已经不理睬科学界的共识，即艾滋病是由一种病毒性传染病所致，通过昂贵的精制药品是可以治疗的，尽管不能治愈。他这种态度是受到一群以艾滋病否认派著称的人的影响的。这群艾滋病否认派中最出名的是加利福尼亚大学伯克利分校的彼特﹒杜斯伯格。
2000年，姆贝基召集了一次圆桌专家会议，与会专家包括杜斯伯格及其支持者，同时也有他们的反对者，一起探讨艾滋病的成因。当年年末，在南非德班召开的一次国际艾滋病大会上，他公开批驳已被接受的科学提法。他说，艾滋病是免疫系统的崩溃所带来的，而不是一位某种病毒带来的。
他说，免疫系统崩溃的原因是贫穷、缺乏营养以及普遍的不健康。其解决方法不是靠昂贵的西药，而是靠减少非洲的贫困。
哈佛大学研究人员在一份新近公开的论文中，定量计算出了由于姆贝基的立场所造成的死亡人数。姆贝基的立场导致他拒绝接受外界免费提供的药品，而且令其政府拖延了引进医疗计划。甚至是在姆贝基离任后，即使是在强大的国际批评声中，他们仍然对这个问题采取一种沉默态度。
“我们的论点是，南非政府成为了给艾滋病患者提供医疗的一个主要障碍，” 位于波士顿的哈佛大学公共卫生学院的pride chigwedere 博士及其同事在《获得性免疫缺陷综合症杂志（jaids）》撰文道。
他们通过将2000年至2005年之间邻国博茨瓦纳和纳米比亚的大规模治疗计划与南非提供的很有限的药品进行对比，得出了他们的计算结果。
在积极分子的运动和公众的压力下，昂贵的抗逆转病毒药物的价格有了大幅的下调。2000年7月，boehringer ingelheim制药公司同意免费提供其药品“卫滋”，这种药品在母亲生产过程能够防止母亲将艾滋病病毒传染给儿童。但是，南非在2002年之前，一直将“卫滋”的发放点限制在每个省份只有两处。
在国际社会的压力下，南非终于于2003年8月启动了一项预防由母亲将艾滋病传染到儿童身上的全国性运动，并于2004年启动了一项成人治疗的全国性运动。但是该论文作者们估计，到了2005年，药物覆盖率仍然只有23％，母亲传染到儿童的预防率还不足30％。
相比较之下，到2005年，博茨瓦纳已经获得了85％的治疗覆盖率，纳米比亚的治疗覆盖率也达到了71％，两国的预防由母亲将艾滋病传染到儿童身上的全国性运动覆盖率都达到了70％。
这些作者估计，在那个期间，南非有33万以上的人死于无辜，而且还有35，000个感染艾滋病病毒儿童出生，这些儿童原来完全可以免除这种病毒，而且可以有一定的寿命。
他们的计算结果是经得起审核的，他们说。“分析是稳健的，”chigwedere说。“我们使用了一种透明的容易进行的计算法以及可以公开获得的数据，而且，在我们做推测的地方，我们都做了基本解释。
“我们是有目的地选择非常保守的假定，而且还做了敏感性分析，以检测所得的结果在使用到一个不同的假定时是否有质的变化。”
这些作者的结论是：“采用哪些适当的公共卫生做法通常都是由少数政治领导人来决定的。在南非这个例子里，很多生命的失去，都是因为政府不接受及时使用‘卫滋’来防止和治疗艾滋病病毒/艾滋病所致。”
在姆贝基今年9月份离开南非国民大会的领导职位之后，在新任卫生部长barbara hogan的领导下，南非目前迫切需要的是推行新政，为尽可能多的人获得治疗